Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1518549872 |
---|---|
Provider Name | Ms. Tamara Jones |
First Address | Mesquite, TX 75150-4142 |
Second Address | Mesquite, TX 75149-5983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2021 |
Last Update Date | 26/04/2021 |